March 14 kicks off Patient Safety Awareness Week, an annual recognition of the essential need to improve safety in all settings.
For nurses, awareness about patient safety impacts every aspect of their work. From medication prescriptions and delivery, to diagnoses and follow up, to ambulatory safety and safety of those who are bedridden, to the treatment of conditions and issues that affect virtually every area of the body, nurses place safety at the very top of the list of what they do.
No matter how careful healthcare workers are and how much they prioritize patient safety, there’s always room for improvement. And the numbers are alarming when it comes to the widespread impact errors have. According to the World Health Organization, as many as 4 in 10 patients are harmed in primary and outpatient healthcare situations across the globe. Of the harm done, more than three-quarters of the cases are preventable and the most harmful errors fall under medication use, prescriptions, and medical diagnosis. Even treatment in some of the highest income nations with excellent healthcare isn’t entirely protective. One in 10 patients suffers harm in a hospital setting in these countries and almost half of those errors are preventable.
Organizations including the Center for Patient Safety and the Institute for Healthcare Improvement (IHI) advocate for attention to common ways where patients are harmed during healthcare treatment. Resources such as the Patient Safety Essentials Toolkit from the IHI can help nurses and nursing teams assess their typical workflow and make changes that can have a big impact on outcomes. From the SBAR (Situation-Background-Assessment-Recommendation) technique to better communication, even small adjustments in the way a unit operates can improve patient outcomes and safety for both patients and staff.
The opportunity for improvement is extensive. According to the WHO, patient harm occurs on many levels and in varied settings. From medication error to infection prevention practices to radiation errors or unsafe injection practices, the potential for mistakes occurs across the spectrum of care. It can also include harm such as falls and other unintentional injury.
Nurse leaders and healthcare management can also promote a culture of safety for all, because a workforce that feels protected will likely have the resources and culture in place necessary to promote safety for patients as well. In one study Does Employee Safety Matter for Patients Too? Employee Safety Climate and Patient Safety Culture in Health Care, the authors found that increased focus on employee safety had a positive correlation to safety for patients and better outcomes.
As a nurse, educating yourself about the latest evidence-based safety practices is always good professional development, as is learning new skills. Take courses, read journals, and investigate what other healthcare settings are doing successfully. Promote safety practices on your unit and advocate for opportunities to learn more about protecting your patients at work, whether that’s through speakers, seminars, or with hands-on education and projects.
What is one thing you can do to elevate your own practice this week?
It’s no secret—most nurses don’t get enough sleep. While many Americans admit to not getting enough shut eye, the implications for nurses are far reaching.
The National Sleep Foundation recognizes this week (March 8 – 14) as National Sleep Awareness Week. The irony isn’t lost on nurses that a week devoted to sleep coincides with National Patient Safety Awareness Week (and the switch to Daylight Savings Time and an hour of lost sleep). Patient safety depends on a healthcare workforce that’s able to perform at a consistently high level. Getting less-than-optimal sleep or not sleeping enough cuts into everything from reaction time to memory and has a big impact on the quality of care offered by sleep deprived nurses.
How serious is sleep deprivation to nurses? As many people know, getting enough good-quality rest takes an effort and some planning. For nurses, who tend to have sleep disrupted even more because of changing shift work, planning for a consistent pattern of sleep is a huge challenge.
Last December, a study by researchers at the Rory Meyers College of Nursing found that nurses are getting less sleep before they head to work than they should. The study found “sleep deprivation hurts workers’ ability to handle complex and stressful tasks. … In healthcare, fatigued nurses may be a risk for making critical mistakes in administering medication or making clinical decisions.” Many factors influenced nurses and sleep including changing shifts, length of shifts, commuting time, and family responsibilities, and there’s often little nurses can do to change those major influences. The report, say the authors, is evidence that the overall working environment in healthcare needs an overhaul, especially in areas of overtime, scheduling, and prioritizing sleep.
If nurses can’t change their major responsibilities, there are a few other things they can do that can help them get more rest. Awareness about the impacts of poor sleep and not enough sleep is critical for nurses. While some people can get by skimping on sleep, patients depend on nurses being in top form.
If sleep is a problem for you, here are some things to consider.
Physical issues like sleep apnea or restless legs syndrome can disrupt your sleep.
Shift Work Disorder is directly related to those who work varying shifts and disrupt their circadian rhythms.
For women, hormones can play a big role in sleep disruption.
Family responsibilities like waking children, active teens, and even caring for aging parents can interrupt your sleep.
Stress keeps you up at night.
Fixing the problem starts with identifying it, so take some time to figure out what’s happening in your own life. Making your sleep a priority is probably one of the best ways to get more rest, but it’s also the hardest. Realize that getting your best sleep likely means sacrifice in some other area.
Start with a complete physical if you think apnea, restless legs, or chronic insomnia might be keeping you up. Then make small, incremental changes—maybe by getting to bed 15 or 30 minutes earlier. Assess your bedroom and see if you can make changes to adjust the comfort level in any way. Can your bedtime routine be adjusted at all to give you a little more quiet or a little more routine so your body is triggered into sleep mode. Take a hard look at your responsibilities—can you get help with anything or can you let some things go? What small changes can you make to reduce your stress (therapy, a 10-minute walk, a few minutes to read or to listen to a funny podcast on your commute)?
Getting enough rest is one of the easiest health priorities to let slide. As a nation of sleep-deprived people, you might feel like your issue is no different from anyone else’s. That might be true, but nurses especially owe it to themselves to be as well rested as possible. Your job is physically and mentally exhausting, even on the good days. Restorative sleep helps your body and mind recover and helps keep you at the top of your game.
With COVID-19 making a rapid advance across the globe, this week’s recognition of Patient Safety Awareness Week draws attention to a critical subject.
Sponsored by the Institute for Healthcare Improvement (IHI), nurses can use the week to learn new standards and practices, especially in light of COVID-19, and can also educate patients and their caregivers on how to protect themselves across the healthcare spectrum.
The numbers are especially alarming when patients and healthcare workers realize those numbers are attributed to preventable events and mistakes. As a nurse, you know lives depend on you paying attention to everything you do. Your patients and colleagues depend on your high-quality care and top-notch performance every single day you’re at work. With those kinds of standards, nurses know patient safety is a top priority.
Patient safety has a clear spillover impact into other areas of healthcare—workplace safety in particular. When patient safety is compromised, nurses’ safety is compromised. And it doesn’t take much to create unsafe situations.
Think of these examples:
Moving a patient without proper equipment or sufficient staff. As a result, the patient is exposed to a risk of falling and the nurse is now more likely to have a physical injury from trying to move the patient in unsafe circumstances.
Sharps or equipment being improperly stored or disposed of exposes patients and nurses to disease and injury
Medication errors because there is no established process for reducing error
Infections due to lack of proper hygiene
As a nurse, you can take steps every day to ensure and promote patient safety.
If you notice a process that could become or already is creating a safety concern, address it with your supervisor.
Make sure your attention to safety never wavers and notice when you feel distracted.
Ask for continual professional development opportunities around patient safety.
Propose a process or standard plan around high-risk activities so that it becomes a standard care plan in your organization.
Take care of yourself by getting enough sleep, staying hydrated, eating nutritious foods, and managing your stress.
Practice immaculate personal hygiene and encourage it in your colleagues and in your patients and their caregivers. Thorough hand washing protects everyone.
Lobby for patient and healthcare worker safety in local and national government and in organizations. Even a simple letter to a representative or supporting a professional organization that works for these issues can help.
Becoming an advocate for patient safety is part of any nurse’s focus. In your daily work, spread the word and educate anyone who will listen. Talk about patient safety to peers, colleagues, patients, family members, and other caregivers. Raising awareness with simple and continual discussion can make a significant impact—in the lives of your patients and in your own life.
National Patient Safety Awareness Week (March 11 – 17) focuses attention squarely on one thing at the top of every nurse’s list – keeping patients safe.
Minority Nurse spoke with Patricia McGaffigan, RN, MS, CPPS, vice president, safety programs at the Institute for Healthcare Improvement (IHI) about the ongoing issues around patient safety and how nurses can continue to implement positive and productive change.
While nurses provide a majority of care in inpatient settings, McGaffigan says the issue of patient safety extends to a wider setting as interprofessional teams are responsible for so many levels of care.
Because of the nurse’s role, they are especially able to impact patient care. “Nurses represent the largest segment of the healthcare workforce, in roles that range from the bedside to the boardroom,” says McGaffigan. “One specific and relatively easy way that nurses can effect change is to become educated in foundational safety science.” Nurses who aren’t trained in safety science can obtain training, and many student nurses receive the training as part of the curriculum. “Nurses are perfectly positioned to be able to identify risks and hazards in their work environments that may be mitigated before harm occurs, and this daily commitment to mindfulness about preventing harm before it happens is vital.”
As nurses, ongoing education, and maintaining and obtaining appropriate certifications help nurses provide the optimal care when they are with patients. Consistency in providing care and following a standard of care plan help patient outcomes as well.
“Nurse-sensitive indicators that reflect structure, process, and outcome are of great importance to nurses.” she says. “As a profession, we want to ensure that we have appropriate numbers of skilled nursing professionals who are able to meet the unique needs of patients and families. Process measures are focused on ensuring that we deliver the right care in a consistent and reliable manner.”
Patient harm can result when there is a lack of guidance or an absent standard to follow, says McGaffigan. For instance, harm can result when patients aren’t regularly repositioned or when oral care in ventilated patients is neglected. Other areas of particular importance include medication errors, falls, hospital-acquired infections, or complications, and other injury.
To provide the best care, nurses must also be able to care for themselves. If they are overly fatigued, do not feel supported or able to thrive in their organizations or if they are working in an organization where a culture of safety is not emphasized, patients cannot receive optimal care and nurses themselves might be at greater risk.
“Nurses are increasingly and very appropriately focused on their own physical and emotional safety, as well as cultures of safety,” she says.
The interactions that build relationships between nurses and patients are key to keeping patients safe. “Nurses are often the profession that has the most interaction with patients and families,” says McGaffigan. “We can consistently strive to identify the needs and preferences of patients and families, and also ask patients and family members what matters to them, and what they might be worried about.” McGaffigan knows this first hand. “As a former pediatric critical care nurse, one of my greatest ‘early warning systems’ was when a parent might tell me that ‘something just doesn’t feel right about my child,’” she says.
When errors do happen, a transparent process to understand what went wrong, assess the cause, and prevent future harm is essential. “Punitive cultures exacerbate reluctance to report near-misses and errors,” says McGaffigan. “Nurses can become more familiar with Surveys of Patient Safety Culture, identify areas where unit and organizational performance is stronger or weaker, and play a key role as leaders and participants in initiatives to improve scores on their survey domains.”
Patient safety continues to evolve as new medical technologies are introduced and as patient care continues to become more complex and more challenging.
“Nurses, as well as our other colleagues in healthcare, have chosen our profession because we have a core value of ensuring that our care is not only technically sound and appropriate, but is safe,” says McGaffigan. “As nursing professionals, we come to work every day to ensure nothing less than safe care. Whether we are in traditional roles at the bedside or as nursing leaders, educating our next generation of nurses, sitting on boards of directors of health care organizations, serving in formal patient safety positions, contributing to progress in the medical device and pharmaceutical industries, or more, we individually and collectively embody safety as our core value.”
Those who enter the profession do so knowing they are often a patient’s greatest advocate and a crucial partner in receiving the best care. “We are committed to creating a world where patients are free from harm,” she says, “and we advocate and anchor our healthcare system to not simply regard safety as ‘one more thing that we do,’ but understand that ‘it is the one thing that must permeate and provide the foundation for all that we do.’”
This week’s annual Patient Safety Awareness Week highlights one of the most important parts of a nurse’s job. Every nurse knows that keeping healthcare providers and patients safe is essential. Sometimes, however, it take a fresh approach to make the issue fresh and foremost.
The National Patient Safety Foundation highlights the issue one week annually, but nurses know they can never let their guards down when it comes to patient safety. In a career where the days are frequently chaotic and unpredictable, having standards and safe practices in place protects everyone. This year’s theme “United in Safety” considers all members of the patient’s team – the patient, the nurses and physicians who care for the patient, and even the support team of family and friends.
If everyone is one the same page and the patient is able to understand a condition and the expected treatment (or has a loved one who can), the outcome is better all around.
In honor of Patient Safety Awareness Week, how can you find some new ways for your team to look at the issue? Talk about patient safety this week and encourage staff and patients to do the same.
What are some topics to bring up? Discuss the importance of open communication between healthcare providers and the patients and their families and give examples of what that means. For example, bring up the importance of honesty. That means both sides will be honest about everything from treatment plans to medication compliance to safety standards.
Talking with patients and their families should include open discussion about letting you know how they feel, if any part of their health has changed,
and especially if they don’t understand parts of the care plan, how to maintain it, or where to go for help if they are having difficulty.
And the NPSF has plenty of tools online to help keep patients and healthcare providers on the same page. Encourage patients to download the Medication White Board or the How to Read Your Pathology Report information sheet. Patients and their families can also fill out a Personal Medical Journal that lists all the personal contact and medical information in one neat packet. Let patients know why this is an essential part of their healthcare plan and how having such clear and accessible information available can prevent medication and treatment errors. After all, if they are on a medication and they forget to mention it in a time of crisis, the healthcare team is going to lack some crucial information. When patients and their care teams can link this kind of cause and effect together, they might be more inclined to see the importance of open communication and exactly what it means.
In the workplace, there are plenty of ways to honor the week and get people to start talking about patient safety.
Ask staff members to wear purple in honor of Patient Safety Awareness Week and then gather them all together for photos. Post pictures using the #PSAW2015 hash tag (you can also include @theNPSF).
With an effort underway to recognize the week nationally, encourage your local legislators to consider the action by writing a short email or by picking up the phone and calling them.
On Thursday, March 12, at 1 pm ET, you can participate in a free webcast “Patients and Families as Partners: United in Safety.” On Wednesday, March 11, an open Twitter chat on patient and family engagement starts at 8:30 pm ET. If you want to join the conversation, use #PSAWunited.
If you use a mix of these approaches, patient safety, always a top and pressing issue, can take on a new life in your organization.
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